Provider Demographics
NPI:1043436975
Name:HUMANIM URGENT CARE SERVICES LLC
Entity Type:Organization
Organization Name:HUMANIM URGENT CARE SERVICES LLC
Other - Org Name:HUMANIM URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-381-7171
Mailing Address - Street 1:6355 WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1071
Mailing Address - Country:US
Mailing Address - Phone:410-381-7171
Mailing Address - Fax:410-381-5137
Practice Address - Street 1:6355 WOODSIDE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1071
Practice Address - Country:US
Practice Address - Phone:410-381-7171
Practice Address - Fax:410-381-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDE6069OtherRAILROAD MEDICARE
MD891MMedicare ID - Type Unspecified